Healthcare Provider Details

I. General information

NPI: 1669644068
Provider Name (Legal Business Name): KALIHI-PALAMA HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89-91 S. KING STREET
HONOLULU HI
96813
US

IV. Provider business mailing address

915 N KING ST
HONOLULU HI
96817-4544
US

V. Phone/Fax

Practice location:
  • Phone: 808-792-5566
  • Fax: 808-792-5577
Mailing address:
  • Phone: 808-848-1438
  • Fax: 808-841-1265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberW20300018-01
License Number StateHI

VIII. Authorized Official

Name: MONIQUE VANDERAA
Title or Position: CFO
Credential:
Phone: 808-843-7238